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Background & Context (I) State of Nigerian Health System: Poor performance Ranked 187 out of 192 health systems assessed (WHO, 2000) Factors responsible for poor performance are multidimensional, but can be broadly grouped into: Fragmentation of the health system characterized by : Inability of government to provide effective leadership & strategic direction in the health sector poor coordination /linkage between multiple actors, including engagement with the community and the private sector

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1/27/20145 PURPOSE: To improve the planning, financing and delivery of sustainable and replicable pro-poor services for common health problems in up to 6 states POLICY AND PLANNING CAPACITY DEVELOPMENT KNOWLEDGE MANAGEMENT MONITORING AND EVALUATION PARTNERSHIPS AND CO-ORDINATION OPERATIONS RESEARCH Output 1 STEWARDSHIP Output 2 STATE SYSTEMS Output 4 VOICE and ACCOUNTABILITY Output 5 Informed citizens Output 3 SERVICES and SUPPLIES GOAL Nigeria's own resources are efficiently and effectively used to achieve the MDGS

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1/27/20148 Baseline survey General Objective: To determine the situation of Health Care Service delivery in PATHS 2 Supported States in Nigeria Specific Objectives: To examine the current status of service availability and use in PHC facilities To examine the status of selected supply- and demand-side health system factors affecting service delivery To update the baseline information for the PATHS 2 logframe for monitoring and evaluating the progress of the programme

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Study Design & Methodology Nigerian healthcare delivery system is structured into: PHC at LGA level (District), SHC (State level) & Tertiary (Fed) All LGAs in the supported states were included in the survey Availability and use of services at PHC, central focus of the study Sampling frame - List of PHC facilities & catchment areas in an LGA - (does not exist in the Nigerian Statistical Structure) Design Option: Enumeration Areas (EAs) provided by NPC & NBS used as sampling frame and nearest HF captured Two EAs randomly selected from each LGA Sixteen (16) HHs randomly selected from 250 EAs Total of 4000 HHs randomly selected for the study (Sample size)

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Output:1.1Number of new and revised federal policies, plans, and legislation developed with PATHS2 support are consistent with National Strategic Health Development Plan (NSHDP) and meet a minimum quality standard 0 Output:1.2Level of compliance with NHA institutionalization process 20% Output:1.3Number of federal agencies with institutional capacity for HMIS 0% Output:2.1Number of new and revised state policies, plans, and legislation developed with PATHS2 support are consistent with National Strategic Health Development Plan (NSHDP) and meet a minimum quality standard 0% Output:2.2Percentage of budgeted State & LGA funds for health being disbursed To be determined from public expenditure review Output:2.3Percentage of health facilities submitting timely and complete HMIS reports To be determined Output:2.4Number of states with adequate institutional capacity for human resource planning 0%

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Output: 5.1Percentage of people in PATHS2 supported LGAs who have heard of and/or participated in public dialogue on public health issues Enugu: 13.6% Jigawa: 12.5% Kaduna: 16.5% Kano: 12.0% Output: 5.2Number of people in PATHS2 supported LGAs who participated in public health dialogue events with good re-call of public health issues To be determined Output: 5.3Percentage of people in PATHS2 supported LGAs who have adequate knowledge on the signs and prevention of common health conditions Overall, 2.9%; Enugu, 0.0%; Jigawa, 3.1%; Kaduna, 11.1%; Kano, 9.8% Output: 5.4Percentage of people in PATHS2 supported LGAs who can correctly identify health service entitlements Overall, 10.0%; Enugu, 16.2%; Jigawa, 8.3%; Kaduna, 10.1%; Kano: 8.5%